NIV Congres

Ongoing organ donor shortage has led to expansion of donor criteria and the transplantation of livers that would previously have been declined. These so called extended criteria donor livers have a higher risk of failure after transplantation. In contrast to traditional static cold preservation, normothermic machine perfusion may reduce preservation injury, improve graft viability, and potentially allows ex-vivo assessment of liver graft viability prior to implantation.

To date, successful normothermic perfusion of livers has been reported only in animal models. We report the first case series of four discarded human livers, which have been successfully perfused normothermically for 6 hours.

Normothermic machine perfusion was successful in all four human donor livers included in this study. There were no technical failures of the perfusion machine and all livers were well perfused and oxygenated. The livers, although discarded for varying reasons, functioned well beyond expectations. Distinct oxygen consumption, continuous bile production (possibly the most important outcome parameter for a well-functioning liver) and normalization of the biochemical parameters in perfusion fluid were noted over time in all procedures. Histological examinations confirmed adequate preservation of liver viability.

This study shows that normothermic machine perfusion of human donor livers is feasible and offers a great future perspective in the field of liver transplantation. Normothermic perfusion of ECD livers allows assessment of graft viability before transplantation, and opens new avenues for selection, therapeutic interventions and preconditioning.